As the only medical professional in a building with nearly 900 students, Girls’ High school nurse Anne Smith is busy every day in a regular year.

With a pandemic raging, Smith is now drowning, she said.

Smith left work at 8 p.m. on Tuesday. She had been at school more than 12 hours, seen 21 students, tested 10 for COVID-19. There were jobs left to do when she walked out the door, but she was too exhausted to continue. And the veteran nurse — who has 21 years as a school nurse, and nearly 40 in the profession — sees a crisis in the Philadelphia School District.

“They don’t have the manpower to handle the pandemic,” Smith said. “One nurse in each school can’t do it.”

Smith and other Philadelphia School District nurses are performing two jobs, they say: their regular work, plus essentially functioning as chief COVID-19 officers in their buildings, charged with contact tracing, administering tests to students, a mountain of compliance work, and more. With new variants and cases spiking, many nurses say they are overburdened and lack critical supplies and adequate support to do their jobs.

And some city schools lack even a full-time nurse.

There are 17 school nurse vacancies and seven nurses out on sick leave; nurses who typically assist others are covering for some of those roles, but 11 schools have no full-time nurses, and two are sharing a full-time nurse. Contracted nurses and substitutes fill some but not all gaps; in other situations, nurses are pulled from their schools to administer medication at other schools, leaving their home school without medical coverage.

It’s a situation that Jerry Jordan, president of the Philadelphia Federation of Teachers, calls “untenable and perilous.” The district, the union chief said, “is at a precipice, and without swift remedial action, the health of our students and staff will be further jeopardized.”

The issues are happening amid a tough labor market generally, with an acute nursing shortage. Travel nurses can command upward of $8,000 a week at the moment.

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Superintendent William R. Hite Jr. said the system was hit with a rash of resignations just before the school year began but still has more nurses than at any other time in its history. After deep nursing cuts 10 years ago, under a prior administration, Hite vowed to put a full-time nurse in every school. (Pennsylvania requires that schools employ one nurse per every 1,500 students. Practically, this ratio means that buildings can go uncovered as nurses rotate between schools.)

Nurses serve “a critical function” and the district is working to alleviate the school nurse shortage, the superintendent said, adding that the district is “actively pursuing” increasing nurse compensation. He did not say how much extra money nurses might receive. Under the current contract, beginning nurses are paid $47,192. Nurses at the top of the scale, who have doctorates, earn $90,328.

Eileen Duffey-Bernt, the nurse at Academy at Palumbo, a South Philadelphia magnet school with 1,100 students, used to have an assist nurse one day a week. Now she’s on her own.

Add COVID-19 responsibilities to the already tall pile of work she had, and there are some parts of her job that she just can’t do, said Duffey-Bernt, the 2021 Pennsylvania School Nurse of the Year.

“I have enough experience that if I decide I’m not going to follow the letter of the law, I know exactly how much I can get away with,” Duffey-Bernt said. “I’m absolutely willing to go the extra mile, but we’re being asked to do two full-time jobs.”

Positive COVID-19 cases among staff or students require extensive contact tracing and a mountain of documentation, Duffey-Bernt said.

“None of us are screaming that we want them to close the schools; everybody would like the schools to be open,” she said. But a few weeks into the school year, “people look really worn.”

Supplies are also a problem in some schools. At Penn Alexander, a K-8 in West Philadelphia, school nurse Natanya Gornstein-Talotti has 1½ precious boxes of COVID-19 tests. (Each box has 38 tests.)

“We don’t have any tests, or we’re sharing with other nurses; I have to be careful about how I use my tests,” said Gornstein-Talotti. District protocol says a child needs only one symptom from a list of 20 to be tested, but nurses simply don’t have the resources to test everyone who comes in with one symptom, she said.

Nurses are being asked to drive to district headquarters to pick up tests and other supplies, but Gornstein-Talotti can’t find the time in her busy day to leave school and drive to Center City.

School nurses must maintain not only their nursing license but also obtain and pay for additional education to earn the instructional certification the state requires of them.

But “the district is not treating us as if we are heroes right now,” said Gornstein-Talotti. “We’ve been pretty overlooked.”

Chris Yancer, the school nurse at Mastbaum High, worries about a lack of continuity of care at schools with vacancies. And despite 24 years as a school nurse, she’s feeling overwhelmed.

“My concern is if I’m feeling the pressure, I can’t imagine what our newer nurses are feeling,” Yancer said. “There’s just not enough hours in the day to give everyone what they need.”

It’s a lonely, high-stakes job, school nurses said. And some have had enough.

With demand for nurses at an all-time high, many Philadelphia school nurses do per diem work to supplement their incomes.

“Working in a hospital during COVID is physically grueling and emotionally taxing, but I know I can look to my left and right and know there’s someone who’s in the same boat who will support me,” said one school nurse, who asked not to be identified for fear of reprisal. “At school, I feel people treat us like bottomless wells that can be continuously drained but never refilled. I’m actively looking to leave.”